RCGP: New approach needed to tackle ‘fragmented’ multimorbidity care (NHE: 7 November 2016)
GP practices are not currently set up to deal with patients living with multiple long-term condition, a new report from the Royal College of General Practitioners (RCGP) said.
The RCGP estimated that by 2025, the number of people living with multimorbidity in the UK is expected to go up from 8.2 million to 9.1 million, costing an additional £1.2bn for health and social care.
However, the report said GPs were being held back from treating patients with multimorbidity by current care structures. The average appointment is just over nine minutes long and includes discussion of two different issues, but this is insufficient to address everything, especially as some patients have over five conditions.
Professor Maureen Baker, chair of the RCGP, said: “Currently, care is mostly channelled towards single disease conditions, resulting in a vast number of our patients receiving fragmented care. We need to tailor the services the NHS provides to better suit our patients’ changing needs.”
She added that it is important collaboration is supported to enable better communication between the primary and secondary care sectors by adopting improved IT systems...read more
NHS admits it “could have done things better” over Queens Road Medical Centre closure (Leicester Mercury: 2 November 2016)
The apology comes in the wake of patients' complaints about the closure of the Queens Road Medical Centre, Clarendon Park, Leicester, earlier this year.
Patients registered at the practice, run by Dr Jonathan Lenten, said their concerns and needs were not addressed by health bosses. Now NHS England has said sorry, and the Leicester City clinical commissioning group (CCG), which managed the closure, has made changes to the way it works.
Katy Wheatley, who was a patient at the centre and a spokesman for the Save the Queens Road Medical Centre campaign, said a key concern was patients not being given any help to find new GPs.
She said: "The information provided to patients by the CCG was poor. It did not help patients. It was a list of practices, but did not help them find a new practice. It seemed easier for it (the CCG) to close the surgery than to find a solution."
Ms Wheatley said some patients were left with the view that decisions were being made by GPs, who comprise the CCG, in the interests of GPs, rather than in the interests of patients...read more
16,000 patient practice on short-term contract as six APMS providers pull out (Pulse: 5 May 2016)
A 16,000 patient practice has been left on a short-term interim contract after six of the seven APMS providers invited by NHS England to tender for the contract pulled out saying it was unviable.
The partners at The Mandeville Practice in Aylesbury, Buckingham handed back their contract last year after being unable to replace a recently retired senior partner, and finding locum costs unsustainable.
Since April, the practice has been run by local APMS provider Practice U Surgeries Ltd, on an 18-month contract.
Former partner Dr Gill Beck says it has been left with ‘no security for its future’, adding that commissioners were now getting to grips with how the practice can be run long-term without destabilising adjacent practices.
Local GP leaders said the practice that was no longer viable under the traditional funding model and which would become a ‘poisoned chalice’ if recruitment problems continued.
Speaking on the current state of general practice at the BMA’s Special Representative Meeting (SRM) this week, Dr Beck told delegates: ‘Within 18 months of my retirement from that practice, my partners handed in their contract.
‘Seven private companies came round to look at this, to see if they would take it over. Six withdrew saying it was financially unviable. My practice has gone to a one-year contract with a private organisation with no security for its future.’..read more
Practices missing payments as support service woes continue (Pulse: 28 April 2016)
GP practices are missing thousands in payments following the outsourcing of a national primary care support service, Pulse can reveal.
Payments missing in some areas of England include those for enhanced services and seniority payments, as practices continue to suffer fallout in the handover.
The news comes as NHS England’s rescue package for general practice, unveiled last week, pledged a crackdown on the long-running payment chaos suffered by practices.
But woes continue to plague practices, with Norfolk LMC reporting that all GMS practices have missed out on their enhanced service payments that were due in mid-April.
Dr Ian Hume, medical secretary for Norfolk and Waveney LMC and chair of the GPC’s practice finance subcommittee, told Pulse that the problems were related to the handover from the local support service to Primary Care Support England (PCSE) - the new national services run by outsourcing firm Capita.
He said: ’There have been some issues with the transfer over from Serco to Capita, which is very similar to what is happening elsewhere....read more
Report exposes NHS England’s failures on managing specialised services (The Guardian: 29 April 2016)
The National Audit Office has exposed another NHS organisation for system-wide failures – poor financial controls, disjointed services, incomplete data and staff with the wrong skills. The culprit is NHS England and its commissioning of specialised services. Specialised services are huge business for the NHS, consuming almost £15bn last year – about 14% of the total NHS budget – and slated for 7% growth in 2016-17. Around 300 health organisations provide at least one specialised service, which cover everything from specific mental health problems to chemotherapy.
The ability of NHS England to manage this budget is crucial – if it cannot control the costs, it will impede the adoption of new treatments and technologies while sucking yet more money into the hospital sector.
NHS England took control of specialised service commissioning from the strategic health authorities in 2013. For trusts struggling to maintain staff numbers it may come as a shock to find in the NAO report that the number of NHS England full-time equivalent staff involved in commissioning specialised services has jumped from 287 to 489 in just two years, taking costs from £20m to £38m.
BMA demands tougher checks on private provision of NHS services (GP Online: 19 April 2016)
The BMA report, Privatisation and independent sector provision of NHS healthcare, calls for research into how the growing role of private providers in the NHS is affecting patients and doctors.
Private providers delivering NHS care should face the same level of CQC regulation as NHS providers, and a requirement to deliver training should be written into their contracts, the BMA report says.
Providers should no longer be able to register with the CQC unless they open up to the same freedom of information requirements as NHS providers, the union’s report warns, and the Health and Social Care Information Centre should publish performance data on both NHS and non-NHS providers...read more
London CCG pursuing prime provider model for MSK (HSJ: 31 March 2016)
Camden CCG will be advertising for a five year, fixed term contract with a lead provider for integrated MSK services on Thursday.
The CCG confirmed to the HSJ it would be issuing a pre-qualification questionnaire for bidders at the end of March.
Based on current spending the contract would be capped at an annual spend of £15m. In the second year, 20 per cent of this would be dependent on outcomes...read more
Why contracting out to private health providers doesn’t always work (The Guardian: 15 March 2016)
The NHS (Reinstatement) bill received its second reading in parliament last week. Its aim is to reverse the creeping privatisation of our health service.
The 2012 Health and Social Care Act opened up the NHS to competition. Since then, there has been a gradual privatisation of health services, some working well, others less so, covering a range of services from general outpatient work, to physiotherapy, ophthalmology, diagnostic and even children’s services.
In the last few years, in order to reduce waiting times, many of my patients who have been referred to gynaecology have been seen at Spire private hospital in Bristol. A few patients have also chosen to go a bit further away to a private hospital in Bath run by Circle for a wide range of specialities – although these are usually our more mobile patients as most prefer to travel locally to their hospital appointments. The general feedback has largely been similar to the local NHS hospital: overall patients have been happy with their experience.
However, there are other services such as hip and knee operations and general surgery offered on the NHS by private providers such as local treatment centres that have caused some worry among GPs and patients. There are fears that they “cream off” the easy work by seeing the well patients, leaving the more risky cases (needing longer inpatient bed days and with higher complication rates) for the local NHS hospitals. This has certainly been my experience of our local treatment centre run by Care UK.
Since it opened in 2009, communication has not always been effective and there is a general sense among GPs of fast patient turnover. The aftercare has not always been there – we have been asked as GPs to refer patients for physiotherapy after surgery when this would normally have been done automatically and in a timely manner if the patient had attended the local NHS trust. Most GPs have never had easy access to physiotherapy services and this has introduced delays and led to slower rehabilitation in patients....read more
Carter: Diagnostic services should hit new targets, merge, or outsource (HSJ: 22 January 2016)
Trusts that cannot achieve new benchmarks for pathology will have to agree by next January to outsourcing or sharing services with other providers, Lord Carter is expected to recommend.
The peer, appointed last year to lead a review of hospital efficiency, is to urge the government to set tough deadlines for organisations to either hit new standards or give up control of their pathology services.
The recommendation is in a draft copy of his as yet unpublished report to health secretary Jeremy Hunt, HSJ understands. The Labour peer believes the NHS can save £250m on the annual costs of pathology, thought to be £2.5bn-£3bn a year.
But the estimates have been bedevilled by poor information, much as previous reviews of pathology have been. Lord Carter was first asked to review NHS pathology services in 2005, and his work then estimated there was £250m-£500m in potential savings.
Data for the new draft report came from a cohort of 32 trusts. HSJ understands the recommendation is that trusts will have to sign up to a pathology quality assurance dashboard by July this year, with the Health and Social Care Information Centre publishing standardised definitions of NHS pathology tests in October...read more
King's Fund: H&SC Act has made NHS 'incredibly complex and fragmented' (Health Investor: 10 December 2015)
The Health & Social Care Act 2012 (H&SC Act) has left an NHS which is "incredibly complex and fragmented" The King's Fund chief executive Chris Ham has said.
Despite this, Ham said that the NHS would not benefit from another top-down reorganisation, but required "reform from within" in order to streamline the health system.
Speaking at a Cambridge University Land Society event in central London, Ham said: "There are examples in some parts of the NHS - for instance Salford Royal NHS Foundation Trust - that are high-performing organisations which have brought about change from within. But these institutions did not become high-performing overnight, or in three to five years. They're still on the journey [and] five to 10 years would be an ambitious timescale [to achieve everything].”
Ham also criticised chancellor George Osborne's announcement of a new social care precept of 2% on council tax. He said the changes would not go far enough given the "very challenging" environment that social care providers were in.
If left unchecked, mounting financial pressure on residential care providers would "create a greater dichotomy between those self-funders who can afford to buy their own care, and those who are publicly funded. [The latter] will rely on a threadbare safety net which will increasingly be available only in some places".
He added that public-facing domiciliary care operators were facing the issues, and that some were "struggling to make ends meet".
Mental health contract could land CCGs with extra costs (HSJ: 1 October 2015)
Clinical commissioning groups in Birmingham have jointly tendered a service to integrate mental health services for children with those for adults aged 25 and under. The contract is worth £23.7m per year, and has been awarded to a consortium called Forward Thinking Birmingham.
According to Birmingham CrossCity CCG’s board papers, an external impact assessment, conducted after the contract was awarded, “reveals a potential cost pressure to CCGs and the need for further analysis… particularly in financial terms”.
The CCG is affected by the contract, although the tender was led by Birmingham South Central CCG.
HSJ understands much of this new cost pressure will arise from “stranded costs”. Birmingham and Solihull Mental Health Foundation Trust – the current provider of services for people aged 16 and over – says it will lose £14.2m a year in revenue as a result of the transfer but it may not be able to cut expenditure by the same amount...read more
The outsourcing of NHS services is a growing threat (Richard Bourne in Left Foot Forward: 21 September 2015)
With widespread opposition (plus some common sense) the attempt to drive the privatisation of NHS clinical services appears to be stalling. But as one threat diminishes, at least for now, a new one arises: there are increasing attempts to privatise non-clinical services. Outsourcing is now the big threat. Think back to the Thatcher years and the wholesale destabilisation of our local authority services through compulsory competitive tendering. The council’s lost their direct labour teams and private companies got rich pickings from taking contracts.
The range of NHS service that are coming under threat range across payroll, finance, IT, through catering and transport, to pathology and sterile service. It is true that many of these services are already outsourced in some parts of the NHS but we are now seeing a wholesale drive and the Carter Review will make it worse.
We are also seeing the chaotic but determined drive to kill off NHS shared services and to force the Commissioning Support Units into the private sector. And perhaps worst of all, we are seeing attempts to outsource aspects of commissioning; something that is not supposed to be allowed...read more
GP practices denied millions of pounds in premises funding (GP Online: 15 June 2015)
Councils across England are using planning powers to take millions of pounds from developers to help fund GP infrastructure.
But lack of integration between NHS bodies and councils could mean valuable potential funding is not reaching practices that need it.
Analysis by GPonline found wide gaps between local authorities in use of powers to demand contributions from developers for healthcare infrastructure. Data obtained under the Freedom of Information Act showed that of 173 councils examined in detail, 110 had not used these powers in the four years from 2010/11 to 2013/14.
Specialist healthcare premises lawyers told GPonline that weak integration and communication between councils and fragmented NHS bodies could mean potential funding was not reaching practices that need it.
Nathan East, a partner at law firm Weightmans, said local authorities' links to the NHS were often through CCGs, many of which have little involvement in premises funding.
GPC executive lead for premises Dr Brian Balmer said he would be unsurprised if the ‘impenetrable’ NHS estates system was making it difficult for councils to know how best to funnel funding into primary care infrastructure.
Monitor angers CCGs with advice on community services (HSJ: 23 January 2015)
Commissioners have voiced concern that their efforts to integrate services will be hampered by ‘enforced competition’ after Monitor released a report warning them against simply rolling over existing community services contracts.
The regulator’s report urged clinical commissioning groups to use the end of current contracts – anticipated for many services in 2015-16 – as an opportunity to introduce new care models recommended in the NHS Five Year Forward View.
In a statement released yesterday alongside the report, Monitor said half the CCGs it spoke to with community services deals ending in 2015 planned to extend at least one of their contracts with the current provider. It warned that CCGs should not automatically roll over existing contracts.
CCGs reacted with anger, saying freedom to integrate care should not be blocked by “unnecessary enforced competition”. Catherine Davies, Monitor’s executive director of cooperation and competition, said: “We do not think that commissioners should automatically roll over community services contracts. As the [current contracting] arrangements run out they should take the opportunity to explore ways of improving the community care available to their patients. “Looking to improve services for patients does not mean necessarily putting contracts out to full competitive tender, but it may be the best option in some cases.”
Steve Kell, co-chair of NHS Clinical Commissioners, responded: “We know from our members that CCGs are not automatically rolling over community services contracts, but are actively improving local services by finding and developing local solutions.
“The last thing we need if we are to deliver the better care fund is competition where it is not in the best interest of patients.“This report from Monitor highlights the significant gap between their rhetoric and reality, and it is essential that CCGs are allowed the freedom to deliver integrated care and that this is not prevented by unnecessary enforced competition.”
Potential risk of private contract to Western Sussex Hospitals NHS Trust laid out in impact assessment (Health Investor: 7 January 2015)
An independent report on BupaCSH’s musculoskeletal services (MSK) contract has stated that the new service could “negatively impact” the local NHS trust.
Coastal West Sussex Clinical Commissioning Group (CCG) awarded BupaCSH a five-year, £235 million contract to deliver local MSK services in September 2014. Previously, the services were managed by Western Sussex Hospitals Foundation Trust.
However, Coastal West Sussex CCG and the trust jointly commissioned PwC to carry out an independent assessment of the contract after the trust raised concerns about its impact on wider hospital services.
PwC’s report concluded that it could “achieve benefits” but that the “cumulative impact of loss of MSK services” could add up to £13.4 million over the five-year contract. This would result in the trust falling into deficit. This could happen “specifically if providers conduct outpatient activity but do not also provide inpatient services”.
This news comes after Bedford Hospital NHS Trust refused to sign the contract for local MSK services awarded to Circle in November 2014 due to potential impact on the viability of the trauma service.
NHS services in Nottingham cut after doctors quit rather than work for private firm (The Independent: 16 December 2014)
An NHS hospital has been forced to scrap highly rated services for patients with severe skin conditions, including skin cancer, after an 'exodus' of senior doctors reluctant to work for a private sector subcontractor.
Nottingham University Hospitals Trust said it would no longer be able to provide acute adult dermatology, including emergency care, after losing six of its eight consultants.
Five of those departing are understood to have left rather than transfer to Circle, a private healthcare company which won a contract to provide most of the local dermatology services last year. The closure of the service has raised concerns about the impact of privatisation on the NHS, with doctors worried about job security in the private sector.
The trust lost out to Circle, despite warnings from senior doctors that they would leave rather than be transferred out of the NHS, the Health Service Journal reported.
It is understood that the senior doctors who left were concerned over job stability at a private employer, and also had fears that a profit-driven provider would not offer opportunities for academic research or training.